scholarly journals Perforation Peritonitis at High Altitude

2018 ◽  
Vol 56 (210) ◽  
pp. 625-628 ◽  
Author(s):  
Bhawana Amatya ◽  
Paleswan Joshi Lakhey ◽  
Prativa Pandey
Keyword(s):  
High Altitude ◽  
Distal Gastrectomy ◽  
Acute Mountain Sickness ◽  
Emergency Laparotomy ◽  
Delay In Diagnosis ◽  
First Case ◽  
Life Threatening ◽  
Perforation Peritonitis ◽  
Proper Diagnosis ◽  
Mountain Sickness

Trekkers going to high altitude can suffer from several ailments both during and after their treks. Gastro-intestinal symptoms including nausea, vomiting, and abdominal pain are common in high altitude areas of Nepal due to acute mountain sickness or due to a gastro-intestinal illness. Occasionally, complications of common conditions manifest at high altitude and delay in diagnosis could be catastrophic for the patient presenting with these symptoms. We present two rare cases of duodenal and gastric perforations in trekkers who were evacuated from the Everest trekking region. Both of them had to undergo emergency laparotomy and repair of the perforation using modified Graham’s patch in the first case and distal gastrectomy that included the perforated site, followed by two-layer end-to-side gastrojejunostomy and two-layer side-to-side jejunostomy in the second case. Perforation peritonitis at high-altitude, though rare, can be life threatening. Timely evacuation from high altitude, proper diagnosis and prompt treatment are essential

Commercial flight and patients with intracranial mass lesions: a caveat

2006 ◽  
Vol 105 (4) ◽  
pp. 627-630 ◽  
Author(s):  
Ludvic U. Zrinzo ◽  
Matthew Crocker ◽  
Laurence V. Zrinzo ◽  
David G. T. Thomas ◽  
Laurence Watkins
Keyword(s):  
High Altitude ◽  
Acute Mountain Sickness ◽  
Neurological Deterioration ◽  
Mild Degree ◽  
Airline Passengers ◽  
Life Threatening ◽  
High Altitude Cerebral Edema ◽  
Mountain Sickness ◽  
Commercial Flight ◽  
Mass Lesions

✓The authors report two cases of neurological deterioration following long commercial flights. Both individuals harbored intracranial space-occupying lesions. The authors assert that preexisting reduced intracranial compliance diminishes an individual’s reserve to accommodate the physiological changes resulting from a commercial flight. Airline passengers are exposed to a mild degree of hypercapnia as well as conditions that simulate those of high-altitude ascents. High-altitude cerebral edema following an ascent to great heights is one facet of acute mountain sickness and can be life threatening in conditions similar to those present on commercial flights. Comparable reports documenting neurological deterioration at high altitudes in patients with coexisting space-occupying lesions were also reviewed.

Accuracy and Reliability of Pulse O2 Saturation Measured by a Wrist-worn Oximeter

2021 ◽  
Author(s):  
Eric Hermand ◽  
Clemence Coll ◽  
Jean-Paul Richalet ◽  
Francois J. Lhuissier
Keyword(s):  
High Altitude ◽  
Healthy Subjects ◽  
Acute Mountain Sickness ◽  
Absolute Error ◽  
Error Rates ◽  
Good Reliability ◽  
Intraclass Correlations ◽  
Life Threatening ◽  
Mountain Sickness ◽  
Rest And Exercise

AbstractThis study aims to evaluate the accuracy of the Garmin Forerunner 245 heart rate (HR) and pulse O2 saturation (SpO2) sensors compared with electrocardiogram and medical oximeter, from sea level to high altitude. Ten healthy subjects underwent five tests in normoxia and hypoxia (simulated altitudes from 3000 to 5500 m), consisting in a 5-min rest phase, followed by 5-min of mild exercise. Absolute error (±10 bpm for HR and ±3% for SpO2, around criterion) and intraclass correlations (ICC) were calculated. Error rates for HR remained under 10%, except at 3000 m, and ICCs evidenced a good reliability between Garmin and criterion. Overall SpO2 was higher than criterion (P<0.001) with a >50% error rate (>80% above 4800 m), and a poor reliability with criterion. The Garmin device displayed acceptable HR data at rest and exercise for all altitudes, but failed to provide trustworthy SpO2 values, especially at high altitude, where a pronounced arterial O2 desaturation could lead to acute mountain sickness in hypoxia-sensitive subjects, and its life-threatening complications; moreover, readings of overestimated SpO2 values might induce trekkers into further hazardous behavior by pursuing an ascent while being already at risk. Therefore, its use to assess SpO2 should be proscribed in altitude for acclimatization evaluation.

Headache at High Altitude

2018 ◽  
pp. 3-7
Author(s):  
Renee N. Salas
Keyword(s):  
High Altitude ◽  
Sea Level ◽  
Laboratory Testing ◽  
Acute Mountain Sickness ◽  
Vital Signs ◽  
Medical Practitioners ◽  
High Altitude Pulmonary Edema ◽  
Life Threatening ◽  
High Altitude Cerebral Edema ◽  
Mountain Sickness

Headache is a condition that medical practitioners commonly encounter with a broad differential that ranges from the benign to the life threatening. High altitude environments have unique diseases that present with headache, which this case will outline. Providers practicing at high altitude must be facile with diagnosing these conditions such as high altitude headache and acute mountain sickness. Astute providers must also assess for high altitude cerebral edema and high altitude pulmonary edema as they can co-exist with acute mountain sickness. Given that radiographic and laboratory testing are often not available, determining a diagnosis based on history and physical is essential with the knowledge that “normal” vital signs differ from that of sea level.

Optic nerve sheath diameter changes at high altitude and in acute mountain sickness: meta-regression analyses

2020 ◽  
pp. bjophthalmol-2020-317717
Author(s):  
Tou-Yuan Tsai ◽  
George Gozari ◽  
Yung-Cheng Su ◽  
Yi-Kung Lee ◽  
Yu-Kang Tu
Keyword(s):  
Optic Nerve ◽  
High Altitude ◽  
Acute Mountain Sickness ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Cochrane Library ◽  
Regression Analyses ◽  
Spline Regression ◽  
Nerve Sheath ◽  
Mountain Sickness

Background/aimsTo assess changes in optic nerve sheath diameter (ONSD) at high altitude and in acute mountain sickness (AMS).MethodsCochrane Library, EMBASE, Google Scholar and PubMed were searched for articles published from their inception to 31st of July 2020. Outcome measures were mean changes of ONSD at high altitude and difference in ONSD change between subjects with and without AMS. Meta-regressions were conducted to investigate the relation of ONSD change to altitude and time spent at that altitude.ResultsEight studies with 248 participants comparing ONSD from sea level to high altitude, and five studies with 454 participants comparing subjects with or without AMS, were included. ONSD increased by 0.14 mm per 1000 m after adjustment for time (95% CI: 0.10 to 0.18; p<0.01). Restricted cubic spline regression revealed an almost linear relation between ONSD change and time within 2 days. ONSD was greater in subjects with AMS (mean difference=0.47; 95% CI: 0.14 to 0.80; p=0.01; I2=89.4%).ConclusionOur analysis shows that ONSD changes correlate with altitude and tend to increase in subjects with AMS. Small study number and high heterogeneity are the limitations of our study. Further large prospective studies are required to verify our findings.

scholarly journals A Prospective Epidemiological Study of Acute Mountain Sickness in Nepalese Pilgrims Ascending to High Altitude (4380 m)

PLoS ONE ◽  
2013 ◽  
Vol 8 (10) ◽  
pp. e75644 ◽  
Author(s):  
Martin J. MacInnis ◽  
Eric A. Carter ◽  
Michael G. Freeman ◽  
Bidur Prasad Pandit ◽  
Ashmita Siwakoti ◽  
...  
Keyword(s):  
High Altitude ◽  
Epidemiological Study ◽  
Acute Mountain Sickness ◽  
Prospective Epidemiological Study ◽  
Mountain Sickness

Abstract 14359: Single Nucleotide Polymorphisms in Genes Involved in L-arginine / Dimethylarginine Metabolism Predispose for Pulmonary Hypertension and Acute Mountain Sickness at High Altitude

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Juliane Hannemann ◽  
Julia Zummack ◽  
PATRICIA SIQUES ◽  
JULIO BRITO ◽  
Rainer Boeger
Keyword(s):  
Pulmonary Hypertension ◽  
Relative Risk ◽  
Genetic Variability ◽  
High Altitude ◽  
Acute Mountain Sickness ◽  
Minor Allele ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Mountain Sickness ◽  
Study Participants

Introduction: Chronic (CH) and chronic-intermittent (CIH) exposure to hypoxia at high altitude causes acute or chronic mountain sickness and elevation of mean pulmonary arterial pressure (mPAP). This is paralleled by increased plasma levels of ADMA, an endogenous inhibitor of NO synthesis. ADMA is cleaved by dimethylarginine dimethylaminohydrolase (DDAH1 and DDAH2), whilst symmetric dimethylarginine (SDMA) is cleaved by AGXT2. Arginase (ARG1 and ARG2) competes with endothelial NO synthase (NOS3) for L-arginine as substrate. We have shown previously that baseline ADMA (at sea level) determines mPAP after six months of CIH; cut-off values of 25 mm Hg and 30 mm Hg are being used to diagnose high altitude pulmonary hypertension. Hypothesis: We hypothesized that genetic variability in genes coding for core enzymes of ADMA, SDMA, and L-arginine metabolism may predispose individuals for high altitude disease and pulmonary hypertension. Methods: We genotyped 16 common single nucleotide polymorphisms in the NOS3, DDAH1, DDAH2, AGXT2, ARG1 and ARG2 genes of 69 healthy male Chilean subjects. Study participants adhered to a CIH regimen (5d at 3,550m, 2d at sea level) for six months. Metabolites were measured by LC-MS/MS; mPAP was estimated by echocardiography at six months, and altitude acclimatization was assessed by Lake Louise Score and arterial oxygen saturation. Results: Carriers of the minor allele of DDAH1 rs233112 had a higher mean baseline ADMA level (0.76±0.03 vs. 0.67±0.02 μmol/l; p<0.05), whilst the major allele of DDAH2 rs805304 was linked to an exacerbated increase of ADMA in hypoxia (0.10±0.03 vs. 0.04±0.04 μmol/l; p<0.02). Study participants carrying the minor allele of ARG1 rs2781667 had a relative risk of elevated mPAP (>25 mm Hg) of 1.70 (1.56-1.85; p<0.0001), and carriers of the minor allele of NOS3 rs2070744 had a relative risk of elevated mPAP (>30 mm Hg) of 1.58 (1.47-1.69; p<0.0001). The NOS3 and DDAH2 genes were associated with the incidence of acute mountain sickness. Conclusions: We conclude that genetic variability in the L-arginine / ADMA / NO pathway is an important determinant of high altitude pulmonary hypertension and acute mountain sickness. DDAH1 is linked to baseline ADMA, whilst DDAH2 determines the response of ADMA to hypoxia.

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